Action to STOP Clawbacks!

Posted June 21, 2019

It’s been easy to offer strong support for An Act relative to limits on insurers’ retroactive clawbacks for mental health and substance use disorder services (S.589 and H.1078), filed by Senator Cindy Friedman and Representative Jim O’Day. And I have two main reasons:

Number one: I’m a social worker and as such, I have seen the negative repercussions of misguided clawbacks up close. Seen the ways in which they are hurting the ability therapists and providers on the front line of a mounting opioid and related mental health crisis in the Commonwealth.
Number two: My team and I have also been doing a substantial amount of casework relative to chronic contract issues with Unicare/Beacon. In relation to Unicare/Beacon, clawbacks do nothing more than add insult to an existing injury and I have heard as much from many constituents.

These bills simply require insurance companies to submit claim denials and a written explanation within 12 months of the claim being submitted by clinicians treating mental health and substance use disorders. The Joint Committee on Financial Services heard these bills last month and reported them out favorably. These bills are now in the Joint Committee on Healthcare Finance.

Additionally, Senator Friedman filed S.589 as an amendment to the FY20 Senate Budget. I’m proud that the Senate adopted this amendment which is now an outside section of the Senate budget. If the anti-clawback language is retained in the budget conference committee, and if the Governor does not veto it, it will become law when the budget is signed. Please see the related call to action below.

As I mentioned above, a substantial number of constituents have contacted me to voice their support for this legislation, explaining the devastation of clawbacks. Some mental health and substance abuse counselors have even stopped taking patients covered by certain insurers due to frequent retroactive clawbacks costing them thousands of dollars. In rural western Massachusetts there is already a shortage of providers. Losing providers to this bad business in heartbreaking and enraging all at once.

It’s just outrageous that providers on the frontlines of healthcare across the Commonwealth have to worry about being denied payment for services they performed months or even years after they’ve submitted a claim.

Here’s how you can take immediate action. Contact the six budget conferees and tell them that you support the outside sections that contain anti-clawback provisions: